ARTICLE IN PRESS Biomaterials 26 (2005) 2115–2120 A novel non-toxic camptothecin formulation for cancer chemotherapy M. Berradaa, A. Serreqia, F Dabbarha, A. Owusub, A. Guptaa, S. Lehnertb,* b a Bio Syntech Canada Inc, 475 Armand-Frappier, Laval, Que., Canada H7V 4B3 Department of Radiation Oncology, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Que., Canada H3C 1A4 Received 15 January 2004; accepted 4 June 2004 Available online 8 September 2004 Abstract The use of a novel injectable biocompatible and biodegradable camptothecin-polymer implant for sustained intra-tumoral release of high concentrations of camptothecin is described. The drug delivery vehicle is an in situ thermogelling formulation, which is based on the natural biopolymer chitosan. This formulation, containing homogeneously dispersed camptothecin, was implanted intratumorally into a sub-cutaneous mouse tumor model (RIF-l). The effectiveness of treatment was measured in terms of tumor growth delay (TGD). Animals treated with the polymer implants containing camptothecin had significantly longer TGDs compared to untreated animals as well as to animals treated systemically with camptothecin by intra-peritoneal injection with no evidence of toxicity in terms of loss of body weight. The results indicate that this novel biodegradable polymer implant is an effective vehicle for the sustained intra-tumoral delivery of camptothecin which might also be suitable to deliver other insoluble anti-cancer drugs such as taxol. r 2004 Elsevier Ltd. All rights reserved. Keywords: Drug delivery; Thermally responsive material; Biodegradation; Intra-tumoral; Chitosan; BST-gel 1. Introduction Camptothecin is an inhibitor of the DNA-replicating enzyme topoisomerase I [1] which is believed to act by stabilizing a topoisomerase I-induced single strand break in the phosphodiester backbone of DNA, thereby preventing religation [2,3]. This leads to the production of a double-strand DNA break during replication, which results in cell death if not repaired. The naturally occurring alkaloid was first isolated from the tree Camptotheca acuminata in China in 1966 [4]. In preclinical studies camptothecin, has been shown to be effective against human xenografts of colon, lung, breast, ovarian, and melanoma cancers [5–7]. But in spite of the promise demonstrated at the pre-clinical level, clinical trials were abandoned due to unexpected toxicity and low antineoplastic activity [8–10]. In addition, camptothecin was felt to have limited clinical *Corresponding author. Tel.: +1-514-934-1934-44161; fax: +1-514934-8220. E-mail address: [email protected] (S. Lehnert). 0142-9612/$ - see front matter r 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.biomaterials.2004.06.013 potential because of its low solubility and it has been proposed that local delivery of camptothecin would be a means to achieve effective drug concentrations in brain tumors without the undesirable side effects associated with systemic delivery [11,12]. The therapeutic potential of an intra-tumoral system for delivery of camptothecin was investigated in Fischer rats with intra-cranially implanted 9L gliosarcoma. In this model systemic administration of camptothecin did not extend survival beyond that of controls, however intra-tumoral implant of pCPP-SA wafers containing 50% camptothecin (w/w) resulted in significantly extended survival compared with control group (po0:001) with 4/10 rats surviving longer than 120 days. Survival was also significantly longer than that seen in a group given intra-tumoral BCNU (3.8% w/w) (po0:001). Results obtained with biodegradable polymers in this and other studies are promising, however these devices have the disadvantage that insertion requires surgical intervention. In some cases this can be done when the tumor is resected during the course of conventional treatment. Nevertheless, dependence on an ARTICLE IN PRESS 2116 M. Berrada et al. / Biomaterials 26 (2005) 2115–2120 invasive procedure remains a drawback. Another mode of drug delivery, biodegradable microspheres avoids the need for surgery for insertion since they can be introduced by intra-tumoral injection [13,14]. However, microspheres do not form a continuous film or solid implant with the structural integrity needed for certain prostheses and they may be poorly retained under certain circumstances because of their small size, discontinuous nature and lack of adhesiveness. During the last decade, injectable in situ gel-forming systems have received increased interest in drug delivery and tissue engineering. These devices can overcome many of the problems associated with polymers or microspheres in that they are both injectable and produce solid biodegradable implants with a range of mechanical characteristics in terms of rigidity and load bearing making them compatible with both soft and hard tissues. In the present work, we have used a chitosan polymer to formulate a biodegradable and biocompatible implant for controlled delivery of camptothecin in a slow-release manner directly into a mouse fibrosarcoma (RIF-l) implanted subcutaneously in C3H mice. In this paper, we report the in vitro release characteristics of the camptothecin-polymer implant and the in vivo effect of delivering camptothecin in high concentrations to a murine tumor. The delivery vehicle used is one of a family of thermosensitive chitosan solutions, formulated at physiological pH, which remain liquid at low temperature and turn into gel when heated. The polymeric matrix used in this study consists of chitosan polymer and b-glycerophosphate. Addition of glycerol-2-phosphate (b-GP) to chitosan solution produces a hydrogel which undergoes sol–gel transition at a temperature close to 37 C, making the formulation a suitable vehicle for drug administration since the hydrogel when implanted into the body, flows to fill voids or cavities and becomes solid at body temperature. These hydrogels are suitable carriers for water-insoluble drugs and they are nontoxic and highly biocompatible [15–17]. Chitosan is an important natural polymer widely used for medical and pharmaceutical applications [18]. 2. Materials and methods 2.1. Materials Chitosan (Deacetylation degree DDA. = 85% determined by 1H NMR, Mw=3 105 Da) was obtained from shells of shrimps or lobsters as described elsewhere [15]. Chitosan flakes were dissolved in aqueous hydrochloric acid (0.1 n), filtered, dialyzed and precipitated with aqueous NaOH (6 n). The precipitated chitosan was washed several times with water and vacuum dried. The white chitosan powder obtained was stored in a closed flask until used. The chitosan was ultrapure with no endotoxins, proteins, inorganics and heavy metals. Research grade camptothecin (CPT) and b-glycerophosphate (b-GP) were obtained from Sigma Chemicals. 2.2. Preparation of an autogelling chitosan solution : chitosan/GP Chitosan solutions (1.7% w/w) were prepared in 0.1 m hydrochloric acid at room temperature. The chitosan powders were progressively added to the solvent with stirring and mixture was stirred for a further 3 h. Sterile formulations were obtained by autoclaving (121 C, 20 min) [16]. To 9 ml of cooled chitosan solution, chilled 45% (w/w) b-GP aqueous solution (sterilized through a 0.20 mm filter) was carefully added dropwise to obtain clear and homogeneous liquid solutions in a final volume of 10 ml. This formulation contained 1.53% chitosan, 4.5% b-glycerophosphate. This ratio of chitosan:GP was similar to that previously described [17] and had a thermogelling temperature of 37 C. The final solutions were mixed an additional 10 min at 4 C. The pH of the final cold solutions ranged from 6.9 to 7.2. This clear, autogelling system is proprietary and patented by BioSyntech [17]. 2.3. Preparation of chitosan/GP loaded with camptothecin : chitosan/GP/CPT Homogeneous clear chitosan/hydrochloric acid solutions (1.7% w/w) were prepared, then autoclaved for 20 min at 120 C. Chitosan/CPT formulations were prepared at room temperature by homogeneously dispersing the powdered camptothecin in chitosan solutions at a loading of 4.5% w/w under aseptic conditions. Camptothecin was sterilized by g-irradiation with 25 kGy from a 60Co source (MDS Nordion Inc. Laval, Qc, Canada). Stability of camptothecin after gamma irradiation was confirmed by HPLC (procedure described in Section 2.7 below). Irradiated camptothecin was stored at 4 C along with a control sample of unirradiated powder for up to 2 months. HPLC analysis on non-irradiated and irradiated samples gave identical results indicating that gamma irradiation and storage had not caused any degradation of the drug. b-glycerophosphate was dissolved in distilled water and sterilized by filtration through 0.20 mm filter. The (b-GP solution was added slowly to the cooled camptothecin/chitosan dispersion under aseptic conditions. 2.4. Invitro release study Four hundred and eighty milligrams of fine camptothecin powder, was dispersed in a 10 ml chitosan ARTICLE IN PRESS M. Berrada et al. / Biomaterials 26 (2005) 2115–2120 solution and intimately mixed by stirring (4.5% w/w loading). Immediately after the addition of b-GP solution, the mixture was quickly transferred to a mold to form gels with dimensions 5 15 15 mm3. The mold was pre-coated with a polyethylene glycol solution to facilitate removal after gelation. After an incubation time of l h 30 min at 37 C, the gels were removed from the mold. In this way a matrix containing homogeneously distributed drug was obtained. In vitro release was performed under infinite sink conditions using the molded gel immersed at 37 C in 500 ml of phosphate buffer pH = 7.4 containing 0.6% Tween 20. The dissolution system was shaken at 100 rpm. Samples were removed periodically and the medium was replenished. Released drug was measured by an HPLC analytical method. 2.5. Cells and tumors RIF-1 cells were obtained from Dr. Richard Hill (Ontario Cancer Institute) and were passaged using standard tissue culture techniques in RPMI 1640 media supplemented with 10% fetal bovine serum and 1% antibiotics (all supplied by Gibco BRL). Cells were trypsinized, collected by centrifugation and resuspended in media (4 106 cells/ml) before being injected (50 ml) subcutaneously into the backs of previously shaved C3H mice. Tumors appeared within 10 days and reached a volume of 94–130 mm3 within 3 weeks. Tumor volumes were calculated from measurements taken at three orthogonal angles using the formula (abcp/6). 2.6. Treatment Treatments were begun when the tumors reached a volume of approximately 100 mm3. Tumor-bearing adult female mice (20 g) were separated into 4 experimental groups (n ¼ 627) for the different treatments. One group was an untreated control. Two groups were injected intratumorally with chitosan/GP or with chitosan/GP loaded with camptothecin. 10 ml of chitosan/GP or chitosan/GP/CPT solutions were injected at room temperature using a 26 G needle inserted in the center of the tumor. After injection, the needle was held in place for 3–4 s before being withdrawn to prevent the hydrogel from leaking out of the injection site. The amount of camptothecin incorporated in the hydrogel was such that the total dose administered was 24 mg/kg. In the last experimental group, the mice were injected intra-peritoneally with 50 ml of camptothecin to give a dose of 60 mg/kg. Camptothecin was dissolved for injection a mixture of 8.3% Cremophor EL/8.3% ethanol in 0.75% saline. Tumor measurements were made daily, and the mice were sacrificed when the endpoint (4 initial tumor volume) was reached. All 2117 animal procedures were conducted according to the guidelines of the McGill University Animal Care Committee. 2.7. Measurement of camptothecin by HPLC Quantitative analysis was performed on a Hewlett Packard (Series 1100) chromatographic system equipped with an Autosampler, a solvent module, a UV Detector, and a System HP ChemStations system. The column was a reverse-phase Lichrosphere RP18 (Chromatographic Specialities Inc.) column, (particle size 5 mm, 4 250 mm). The HPLC system was eluted isocratically with methanol: water (63:37; v/v) at room temperature. The flow rate of the mobile phase was 1.0 ml/min and samples were measured at a wavelength of 370 nm. A standard curve was constructed by plotting peak area against concentration. The assay was found to be highly accurate and reproducible, with a coefficient of determination = 0.9999. 3. Results 3.1. In vitro release Chitosan/GP was loaded with camptothecin 4.5% (w/w) and triplicate samples of polymer gels were incubated in phosphate-buffered saline solutions containing 0.6% of Tween 20, pH 7.4, 37 C. At intervals, the supernatant fractions were removed and the medium replenished to maintain the sink conditions. The amount of drug in the supernatant samples was quantified by HPLC and the cumulative percentage of the loaded drug released in the supernatant fractions was plotted versus time. The amount of drug loaded initially in the polymer was confirmed by extraction of the polymer with methanol to release the residual camptothecin. The cumulative release of camptothecin versus time of incubation is shown in Fig. 1. Eighty percent of the drug was released from the implant over 30 days in buffer containing 0.6% of Tween 20. Approximately 13% was released in the first 72 h. The drug release from the formulated chitosan/GP gel was nearly linear under infinite sink conditions, indicating almost zero-order release kinetics in the first four weeks after an initial burst of less than 5% in the first day. The drug remaining in the chitosan/GP which had been immersed in buffer for 4 weeks was extracted with methanol and when this amount was combined with that released over the preceding 4 weeks it appeared that approximately 80% of intact drug loaded in the gels had been recovered. ARTICLE IN PRESS 2118 M. Berrada et al. / Biomaterials 26 (2005) 2115–2120 Fig. 1. In vitro release profiles of BST-gel loaded with camptothecin, 4.5% by weight. BST-gel/CPT immersed in phosphate buffer pH = 7.4 containing 0.6% of Tween 20. Fig. 2. Delay of RIF-1 tumor growth after intratumoral (24 mg/kg) and intraperitoneal (6 mg/kg) injections of camptothecin. O—O No treatment, ’—’ Blank BST-gel, B—B Intraperitoneal injection camptothecin, 6 mg/kg, m—m Intra-tumoral Implant BST-gel/camptothecin, 24 mg/kg. Table 1 TGD following camptothecin treatment by intra-tumoral implant or intra-peritoneal injection Treatment (TGD)7S.D. No treatment BST-gel BST-gel/camptothecin (0.45 mg) Camptothecin i.p 6 mg/kg 6.570.9 6.871.1 25.072.7 7.771.3 3.2. Tumor treatment studies To evaluate its antitumor efficacy camptothecin formulated in chitosan/GP, was injected intratumorally using a RIF-1 mouse tumor model. The RIF-1 tumor has proven to be a useful model for preliminary screening of various compounds for efficacy because of its reproducible growth, non-immunogenicity in the syngeneic host and low frequency of spontaneous metastases. It was only weakly responsive to camptothecin administered by intra-peritoneal injection (Table 1). The effect of the camptothecin containing biodegradable polymer implants on tumor growth delay (TGD) was examined. The results of these studies are shown in Table 1 and Fig. 2. The implanted hydrogel containing 4.5% camptothecin by weight was found to be more effective than systemically delivered camptothecin in delaying tumor growth (TGDs of 25 and 8 days, respectively). Tumors injected with blank chitosan/GP showed no inhibition of growth and had a similar TGD (7 days) as untreated tumors, confirming that the hydrogel alone has no effect on the growth of this tumor. The greater effectiveness of the implant is Fig. 3. Body weight of mice given camptothecin by different administrative routes. The control and the BST-gel only group of mice were sacrificed within 7 days as their tumors reached four times the initial volume. O—O No treatment, ’—’ Blank BST-gel, m—m Intra-tumoral implant BST-gel/camptothecin, 24 mg/kg, B—B Control mice no tumor. presumably due to slow release of the drug in the tumor and the exposure of tumor cells to toxic drug concentrations for a prolonged period of time which causes more cell death than does the short drug exposure resulting from systemic administration. Toxicity of camptothecin was evaluated in C3 H mice with the RIF-1 tumor on the basis of weight loss. None of the experimental groups showed any significant effect of treatment on body weight as is shown in Fig. 3. No ARTICLE IN PRESS M. Berrada et al. / Biomaterials 26 (2005) 2115–2120 topical irritation or any signs of mechanical stress were observed in the case of solid gel implants. 4. Discussion We selected camptothecin as a model drug for this study, because its insolubility in water, makes it difficult to administer systemically by other means and because of the potential applications of camptothecin and the insoluble camptothecin analogues in chemotherapy. Additionally, the pharmacologically important lactone ring of camptothecin and its analogs is unstable in the presence of human serum albumin which results in the conversion of the active drug to the inactive carboxylate form bound to albumin [19–21]. This imposes a severe pharmacokinetic limitation on the systemic use of camptothecin and related compounds. An approach to overcoming this and other shortcomings of camptothecin and its analogs, especially their high systemic toxicity is to load it into a delivery system such as a chitosanbased formulations which will protect the drug from hydrolysis and control its release over a prolonged period. Since the active drug is dispersed and not solubilized there is no possibility of chemical reaction between the active drug and the excipients. There are three primary mechanisms for the loaded drug to be released from hydrogels: swelling, diffusion and degradation. Drug release from chitosan/GP gel with initial water content of 84% (w/w) occurs through the diffusion of water through the polymeric matrix and dissolution of the soluble fraction of the drug. Water is taken up by hydrogels immediately after being exposed to an aqueous media, the rate of water uptake depending on the hydrophilicity of the polymer. As the gel swells the encapsulated drug is released by diffusion through pores. In a study of the release of model compounds from chitosan/GP gels [16] it was found that release occurred largely by diffusion but could be accelerated by weight loss of the gels. Weight loss however occurred much more rapidly than drug was released. This suggested that during the first few hours there is leaching of excess GP and of water which does not contribute to the physical crosslinking of the gel. The physical three-dimensional structure of the gel does not change with time suggesting there is no substantial erosion of the polymer matrix. The third mechanism, which involves degradation of the polymer matrix, would only occur under in vivo conditions as a result of enzyme activity. It is known that chitosans with block structures and lower degrees of deacetylation (DDAo75%) are more readily biodegraded due to the presence of blocks of glucosamine moieties containing acetyl groups that serve as a substrate for lysozyme [22,23]. In the present study, we used chitosan (DDA 85%) that has been 2119 shown to degrade in vivo in about 6 months. No effect of the degree of deacetylation of chitosan on the in vitro release kinetics was observed but the in vivo release kinetics would be expected to be different since in this case the release kinetics is influenced by both the biodegradation of chitosan and by diffusion. Camptothecin delivered systemically resulted in a TGD value of 8 days only, presumably due to the short half-life of the drug and to the fact that the amount that can be injected is limited by systemic toxicity. Giovanella et al. [24] have shown that after intramuscular injection of camptothecin in Swiss nude mice (NIH high fertility strain), camptothecin plasma concentrations decline in a multi-exponential manner, with a mean terminal elimination half-life of about 10 h. At this rate, >99.99% of camptothecin is expected to be eliminated from the systemic circulation within about 3.5 days. In this study estimation of toxicity of chitosan/GP or chitosan/GP/CPT was based on changes in body weight following hydrogel implant. Several published studies describe the effect of implant of chitosan/GP on the histology of the surrounding tissue. The effect of implant in normal tissue has been described by Molinaro et al. [25] as a mild non-specific inflammatory reaction. In the present study the hydrogel was implanted into the tumor. A report of the effect of chitosan/GP/paclitaxel implanted into the EMT-6 tumor described the histology of the implanted tumors as showing some degree of necrosis interspersed between viable tumor tissue with necrosis generally decreasing away from the center of the tumor [26]. This pattern was seen for both chitosan/GP implanted tumors and for those implanted with chitosan/GP/paclitaxel. In the case of the RIF-1 tumor chitosan/GP without drug appears to have no tumoricidal effect so we would not expect to observe the extent of necrosis seen in the EMT6 tumor following implantation of chitosan/GP. Histological changes following implant of chitosan/GP or chitosan/ GP/CPT will be investigated in a projected study. Chitosan has been shown to activate macrophages for tumoricidal activity in mice and guinea pigs [27]. Again, since we found no difference in the tumor response between the untreated mice and those injected intratumorally with chitosan/GP it seems likely that chitosan/ GP does not induce this type of tumoricidal activity against the RIF-1 tumor. The effectiveness of the polymer implant in delaying tumor growth clearly demonstrates the importance of this delivery system in maintaining an inhibitory level of drug over a long period of time. The main advantages of the biodegradable polymer implant such as chitosan/GP used for the delivery of camptothecin to the mouse tumor are the high intra-tumoral concentrations of drug attainable, low systemic toxicity and the extended period of time over which the drug can be released in the tumor. The dose of camptothecin delivered using the ARTICLE IN PRESS 2120 M. Berrada et al. / Biomaterials 26 (2005) 2115–2120 implants was 24 mg/kg, which is 3 times the mean lethal dose for C3H mice, for the implants the delayed release of the drug and localization in the tumor prevents toxic systemic levels being reached whereas a similar dose delivered by bolus injection would be lethal. [8] [9] [10] 5. Conclusion Local delivery of chemotherapeutic agent by controlled-release polymers is a new strategy with the potential to maximize the anti-tumor effect of a drug and reduce systemic toxicity. In this study, we have demonstrated the effectiveness of using the biodegradable chitosan polymer to deliver high doses of camptothecin locally to a mouse tumor model. Growth of tumors treated in this fashion was retarded for significantly longer periods than were tumors treated with systemically administered camptothecin. Camptothecin delivered by intra-tumoral implant showed no toxicity in terms of weight loss. The system formulated with camptothecin was found to be stable and the release profiles of a formulation with chitosan and b-GP showed almost zeroorder release kinetics in the first four weeks after an initial burst of less than 5% in the first day. These findings show chitosan/GP gel to be a safe, effective, homogeneous, injectable and stable formulation for delivery of camptothecin and this approach represents an attractive technology platform for the delivery of other clinically important hydrophobic drugs such as taxol and tetracycline. 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